MEDICARE: DR. THOMAS J. GIBBONS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	15037	TX

General Provider Information

NPI Number	:	1487675880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS J. GIBBONS DDS

Provider Business Mailing Address
First Line	:	6500 GREENVILLE AVE
Second Line	:	SUITE 303
City	:	DALLAS
State	:	TX
Zip	:	75206-1014
Country	:	US
Telephone Number	:	214-696-8096
Fax Number	:	214-696-8095

Provider Business Practice Location Address
First Line	:	6500 GREENVILLE AVE
Second Line	:	SUITE 303
City	:	DALLAS
State	:	TX
Zip	:	75206-1014
Country	:	US
Telephone Number	:	214-696-8096
Fax Number	:	214-696-8095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	03/10/2016

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